NPI | 1073246203 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NC 0010-12258) |
Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: NC 0010-12258) |
363A00000X Physician Assistant (Licence: NC 0010-12258) | |
Enumeration Date | 2022-07-06 |
Last Update Date | 2024-06-17 |